Healthcare Provider Details

I. General information

NPI: 1720378367
Provider Name (Legal Business Name): SHANNON AILEEN DAVIDS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2011
Last Update Date: 02/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CHESTNUT ST 1ST FLOOR
PHILADELPHIA PA
19107-4414
US

IV. Provider business mailing address

833 CHESTNUT ST 1ST FLOOR
PHILADELPHIA PA
19107-4414
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-1085
  • Fax: 215-955-5041
Mailing address:
  • Phone: 215-955-1085
  • Fax: 215-955-5041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD454853
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: